Adult Obesity May Have Origins Way Back In Kindergarten

Playing outside can help kids — and their parents — maintain a healthy weight.

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Originally published on January 30, 2014 2:20 pm

A lot of parents like to think their kids will simply outgrow baby fat. But the risk of becoming a severely overweight adult can actually start as early as kindergarten, research suggests.

"As parents, as a society, as clinicians, we need to think about a healthy weight really early on," says Solveig Cunningham, who led the study. But that doesn't mean putting young children on calorie-restricted diets.

In hopes of figuring out when in life the warning signs of obesity emerge, Cunningham and her colleagues studied more than 7,000 children from the time they started kindergarten through middle school.

"Kids who started off kindergarten overweight actually had about four times [the risk] of becoming obese by eighth grade, compared with normal-weight kindergartners," says Cunningham, an assistant professor in the department of global health at Emory University. And nearly half of the obese eighth-graders , she says, had been overweight kindergartners.

The findings, published Wednesday in TheNew England Journal of Medicine, suggest the "risks for obesity are in part set fairly early in life" — maybe as early as during the mother's pregnancy, Cunningham says. A third of the children who ended up being obese by eighth grade were also on the large side at birth.

Pregnancy and the first few years of a child's life are clearly influential, according to Dr. David Ludwig, a specialist in childhood obesity at Boston Children's Hospital. "Maternal diet, maternal weight gain and the infant's diet during the first few years may have an outsized influence on long-term risk for obesity and related diseases."

That means that women need to be careful not to gain too much weight while they're pregnant, Ludwig says, as well as try to make sure their young children don't sit around too much, watching TV and playing video games. Helping kids get exercise is important, he says, as is helping them develop healthful eating habits.

Teach children to go easy on the refined carbohydrates from the start, Ludwig advises — "the sugary beverages, too much fruit juice and all of the processed, packaged snack foods."

Still, some experts worry that studies like this could lead parents to overreact at any sign that their babies or toddlers are getting a little chubby. "Putting [young children] on a calorie-restricted diet can stunt their growth in height," says Joanne Ikeda, a nutritionist at the University of California, Berkeley. That's definitely not the answer, she and pediatricians agree.

"What you want to do," Ikeda says, "is help them have healthier lifestyle habits and they will grow into their weight."

Children are already suffering from a kind of societal hysteria about childhood weight, according to Linda Bacon, a physiologist who studies weight regulation and nutrition at the University of California, Davis.

"What this is going to do to kids is ... cause more bullying and teasing of the larger kids," she says. "It's going to cause them to feel bad about their bodies. It's going to make the thinner kids really scared of getting fatter. There is so much public and media hysteria about the epidemic of childhood obesity already."

The researchers behind this study don't advocate putting young children on diets or making them feel bad about their weight. They say they just hope their work will help discourage the bad habits that are in large part driving the childhood obesity epidemic.

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Here's some worrying news for parents. The risk of becoming obese seems to start even earlier than we thought. By kindergarten, many kids look like they're already well on their way to obesity. That's according to a big new study released today by the New England Journal of Medicine. NPR's Rob Stein reports.

ROB STEIN, BYLINE: Everyone knows the childhood obesity epidemic is a problem, but Solveig Cunningham of Emory University wanted to see just how early in a child's life the warning signs emerge.

SOLVEIG CUNNINGHAM: This would be a really important thing to focus on and to understand because it lets us know about the ages of vulnerability, when does obesity occur, and who might be at greatest risk.

STEIN: So Cunningham and her colleagues followed more than 7,000 kids when they started kindergarten. They wanted to see who ended up becoming obese by the time they got to middle school. And they found something really disturbing.

CUNNINGHAM: Kids who started off kindergarten overweight actually had about four times greater risks of becoming obese by eighth grade compared with normal-weight kindergartners.

STEIN: A lot of parents like to think their kids will just grow out of their baby fat. But this says that's often not the case. In fact, almost half of all the kids who had become obese by eighth grade were the ones who already were considered overweight in kindergarten.

CUNNINGHAM: One major implication is that the risks for obesity are in part set fairly early in life. So as parents, as a society, as clinicians, we need to think about healthy weight really early on.

STEIN: Really early on meaning even during when a woman is pregnant. The same study found one-third of the kids who ended up being obese by eighth grade were the ones who were on the large side at birth. David Ludwig is a childhood obesity expert at Boston Children's Hospital.

DR. DAVID LUDWIG: A key time period appears to be both pregnancy - a time when the fetus is growing and developing and biological pathways are being established - and also the first few years of life. So maternal diet, maternal weight gain and the infant's diet during the first few years may have an outsized influence on long-term risk for obesity and related diseases.

STEIN: So Ludwig says women have to be careful not to gain too much weight while they're pregnant and do commonsense things during their kids' first few years of life. Make sure their kids don't sit around too much watching TV and playing video games, get them plenty of exercise, and watch what they eat.

LUDWIG: Importantly, avoiding excess consumption of all of the refined carbohydrates that have snuck in our diet over the last few decades - the sugary beverages, too much fruit juice, and all of the processed, packaged snack foods.

STEIN: But some experts worry the new research will cause some parents to overreact at any sign their babies or toddlers are getting a little chubby. Joanne Ikeda is a nutritionist at the University of California, Berkeley.

JOANNE IKEDA: Putting them on a calorie-restricted diet can stunt their growth in height. So you don't want to put children on a calorie-restricted diet. What you want to do is help them have healthier lifestyle habits and they will grow into their weight.

STEIN: Others worry the research will add more fuel to what they think is a kind of hysteria around childhood weight. Linda Bacon of the University of California, Davis says kids are already suffering.

LINDA BACON: What this is going to do to kids is it's going to cause more bullying and teasing of the larger kids. It's going to cause them to feel bad about their bodies. It's going to make the thinner kids really scared of getting fatter.

STEIN: The researchers behind the new study are not advocating putting young children on diets or making them feel bad about their weight. They just hope their work will help discourage the bad habits that are driving the childhood obesity epidemic. Rob Stein, NPR News.

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This is ALL THINGS CONSIDERED from NPR News. Transcript provided by NPR, Copyright NPR.